臨床整形外科45巻3号

2010年03月発行

誌上シンポジウム 軟部腫瘍の診断と治療

悪性軟部腫瘍の治療

著者： 大野貴敏¹

所属機関： ¹岐阜大学医学部整形外科

ページ範囲：P.235 - P.240

　悪性軟部腫瘍の発生頻度は人口10万人あたり2～3人と少なく，日常診療で頻回に遭遇する疾患ではない．しかしながら，誤った初期治療により患者を不幸な転帰に陥らせ得る疾患であり，一般整形外科医であっても，適切な初期対応が求められる．近年の画像診断や化学療法，手術手技の進歩によって，悪性軟部腫瘍の治療方法は大きく進歩した．本稿では，悪性軟部腫瘍の治療を，これまでに確立されたエビデンスをもとに解説する．

参考文献

1) Biclels J, Wittig JC, Kollender Y, et al:Sciatic nerve resection:is that truly an indication for amputation? Clin Orthop 399:201-204, 2002

2) Goodlad JR, Fletcher CDM, Smith MA:Surgical resection of primary soft-tissue sarcoma. J Bone Joint Surg Br 78:658-661, 1996

3) Green FL, Page DL, Fleming ID, et al:AJCC Cancer Staging Manual. 6th ed. Springer, New York, 185-200, 2002

4) Guillou L, Coindre JM, Bonichon F, et al:Comparative study of the National Cancer Institute and French Federation of Cancer Centers Sarcoma Group grading systems in a population of 410 adult patients with soft tissue sarcoma. J Clin Oncol 15:350-362, 1997

5) Holt GE, Griffin AM, Pintilie M, et al:Fractures following radiotherapy and limb-salvage surgery for lower extremity soft-tissue sarcomas. A comparison of high-dose and low-dose radiotherapy. J Bone Joint Surg Am 87:315-319, 2005

6) Jones KB, Ferguson PC, Deheshi B, et al:Complete femoral nerve resection with soft tissue sarcoma:functional outcomes. Ann Surg Oncol published online:20 October 2009

7) Kamada T, Tsujii H, Tsuji H, et al:Efficacy and safety of carbon ion radiotherapy in bone and soft tissue sarcomas. J Clin Oncol 20:4466-4471, 2002

8) Matsumoto S, Kawaguchi N, Manabe J, et al:"In situ preparation" new surgical procedure indicated for soft tissue sarcoma of a lower limb in close proximity to major neurovascular structures. Int J Clin Oncol 7:51-56, 2002

9) McArthur GA, Demetri GD, Oosterom A, et al:Molecular and clinical analysis of locally advanced dermatofibrosarcoma protuberans treated with imatinib:Imatinib Target Exploration Consortium Study B2225. J Clin Oncol 23:866-873, 2005

10) O'Sullivan B, Davis AM, Turcotte R, et al:Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs:a randomized trial. Lancet 359:2235-2241, 2002

11) Pervaiz N, Colterjohn N, Farrokhyar F, et al:A systematic meta-analysis of randomized controlled trials of adjuvant chemotherapy for localized respectable soft-tissue sarcoma. Cancer 113:573-581, 2008

12) Pisters PW, Harrison LB, Leung DH, et al:Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol 14:859-868, 1996

13) Sarcoma Meta-analysis Collaboration:Adjuvant chemotherapy for localized respectable soft-tissue sarcoma of adults:meta-analysis of individual data. Lancet 350:1647-1654, 1997

14) Sugiura H, Takahashi M, Katagiri H, et al:Additional wide resection of malignant soft tissue tumors. Clin Orthop 394:201-210, 2002

15) Zagars GK, Ballo MT, Pisters PWT, et al:Surgical margins and resection in the management of patients with soft tissue sarcoma using conservative surgery and radiation therapy. Cancer 97:2544-2553, 2003